Alison Cross wrote:Hello all - stumbled across this site while trying to find out what the heck is wrong with my hip and have paid for and downloaded the RYB book today.

I've been to the doctor and had an x-ray taken - nothing seems to be wrong bone-wise (which is good!). He signed me up for 6 sessions of physiotherapy and I've been attending religiously, but to be honest, my pain didn't improve. So, I went to an osteopath who said that he reckoned it was my SI joint.

I went twice - got a jolly good cracking up and down my back - but nothing improved.

From what I've read on the internet, I reckon that it is my joint. I'll give you a potted history.

Had my appendix out in mid eighties - nast big scar still there. Had my son by caesar section in 2000 - so abdomen has been well cut up! Developed sciatica whilst pregnant and attended a sports physio after son born - this helped enormously (left hip - down leg, heel pain etc).

Everything pretty much ok until last August. Dancing with son, swung hips out to right side, heard a bit of a crack on right side....no pain....but ever since then, hip pain and back pain been gradually getting worse.

When I lie on my back with my knees up to my chest and rock over my right hip, I can hear a click (not all the time). No noise on left side.

Got a bit of a flat back thing going on (no bottom!) but being doing the cobra to improve that (the physio helped me with this bit).

I spend a lot of time sitting at the computer - and sitting really makes my hip ache. I sometimes feel like I've got a groin strain in my right side too, not all the time though. Walking and cycling are fine - lying in bed and sitting are hellish though. Bed situation improved by putting pillow between my knees.

Just feeling very despondent that this doesn't seem to be getting better. I can't sleep with a pillow between my knees for ever or my hubby will leave me!

Can you wonderful people a) confirm that this joint is the problem and b) that the damned thing can be put right?! :wink:

Best regards - fabulous site btw!

Heck - forgot to say that when I stand and try to curl forward a vertebrae at a time, I get to my lower back and everything just seems to bend forward as a single unit and my pelvis hurts (stretches?) on the right side.

Also, when I lie on the floor and try to let my spine drop onto the floor, vertebrae at a time, by the time I get to my lower back, it just flubs onto the floor like it's all welded together.

I feel like an old lady and I'm 44.

AX

Allison,

From reading your history, it sounds as if you have a classic case of a transversus abdominus muscle that is not functioning or at best, is very weak. It is not possible to say whether or not your SI joint is the cause of your back pain. The beauty of Dean's exercises are that they will help most folks that have back problems because of deconditioned musculature in the lower back and abdomen which happens to be a high % of people that have back pain. For example, the "Prone Cobra" is excellent for developing the intrinsic stabilization musculature of the back. Very often, in folks that have back pain, these smaller stabilizer muscles have lost their ability to help stabilize the vertebrae of the back which can eventually result in various back conditions.

Allison, did your doctor check you for anklylosing spondylitis? Ankylosing spondylitis is an inflammatory condition of the spine which predominantly affects men about twice as often as women. I am mentioning this because you wrote (relating to your description of your lower back) "Everything just seems to bend forward as a single unit". Ankylosed means immobility of a joint. Also, did your doctor say you had a flat back or a sway back? They are different, but look very similar when viewed from the side; both have the flat butt appearance. In either case, I would refrain from doing the Prone Cobra exercise at least until you have developed greater strength in the iliopsoas musculature. This course of action will benefit you whether you have a vertically aligned flat back, or you have a sway back. The reasoning behind my recommendation to avoid the prone cobra are taken directly from "Muscles, Testing and Function" by Kendall, McCreary & Provance ": 1) "Careful consideration must be given to examination findings when planning a course of treatment. It is a mistake to assume that extension exercises are indicated. They may be unnecessary or may be contraindicated. The flat back posture is one in which the hip joint is in extension, and the hamstrings are strong, and usually short. 2) If this type of posture exists without low back pain, it is not necessary to change it. If the back is painful, and restroring the normal anterior curve is indicated, the measure of choice should be strengthening the weak hip flexors. The problems with back extension from prone position are that it involves strong hip joint extension, and extensor muscle action to stabilize the pelvis to the thigh in order for the trunk to be raised, and the hip extension stretches the already weak illiopsoas."

Here is a little information on pain. Central Pain syndrome, which I think most back pain falls under, is damage or disfunction to the brain, brain stem or spinal cord. This type of pain is typically characterized by a constant level of pain; whether it be moderate or severe. With back pain, the level of pain is directly related to the severity of disruption to the nerve(s). Central Pains actions should not be confused or compared to that which is normally felt in peripheral pain.

An example of peripheral pain would be if you stubbed your toe; the amount of pain you feel initially is much greater than what is present 2 or 3 minutes later. In short, as time passes, there is a diminishing quality to the perceived level of pain from the trauma. On the other hand, with back pain or central pain, because of the initiation of mitogin-actived protein kinase within the body, pain can remain at a constant level much longer.

With central pain, the body initiates a complex process that places a high-energy phosphate (kinase) bond on the pain neuro transmitters which can make the affected nerves fire out of control signalling pain. You can feel pain locally or referred (feels as if it comes from one place, but actually comes from somewhere else) or radicular pain, which has that shooting sensation radiating from a nerve root towards its' periphery.

The point I'm trying to make here is don't despair - you may actually have made progress, but your pain level is telling you otherwise. I think when a spinal injection has a successful outcome in alleviating pain, the groundwork had already been laid by the events previous (i.e. exercises, stretches, rest, massage). In cases where the spinal injection is ineffective, the cause (etiology) may still be present, hence the pain eventually returns. However, in cases where the pain is so severe as to be physically debilitating, an epidural may serve to provide sufficient relief from the pain to allow the individual to perform the physical exercises that will form the foundation for the best chance of recovery.

The following is the course of action I would take:
1. Ask your doctor whether he found any indications you may have ankylosing spondylitis?
2. Hold off on performing the Prone Cobra.
3. On days you want to take corrective action (hopefully 3 or 4 times per week), first stretch your hamstrings, followed by an exercise for your illiopsoas muscles.
4. Follow the illiopsoas exercise with a transversus abdominus exercise.
5. Then follow the exercises in Dean's book.

Allison, if you want to follow my suggestions, I will be happy to provide the stretches and exercises.

Alison Cross wrote:Hello all - stumbled across this site while trying to find out what the heck is wrong with my hip and have paid for and downloaded the RYB book today.

I've been to the doctor and had an x-ray taken - nothing seems to be wrong bone-wise (which is good!). He signed me up for 6 sessions of physiotherapy and I've been attending religiously, but to be honest, my pain didn't improve. So, I went to an osteopath who said that he reckoned it was my SI joint.

I went twice - got a jolly good cracking up and down my back - but nothing improved.

From what I've read on the internet, I reckon that it is my joint. I'll give you a potted history.

Had my appendix out in mid eighties - nast big scar still there. Had my son by caesar section in 2000 - so abdomen has been well cut up! Developed sciatica whilst pregnant and attended a sports physio after son born - this helped enormously (left hip - down leg, heel pain etc).

Everything pretty much ok until last August. Dancing with son, swung hips out to right side, heard a bit of a crack on right side....no pain....but ever since then, hip pain and back pain been gradually getting worse.

When I lie on my back with my knees up to my chest and rock over my right hip, I can hear a click (not all the time). No noise on left side.

Got a bit of a flat back thing going on (no bottom!) but being doing the cobra to improve that (the physio helped me with this bit).

I spend a lot of time sitting at the computer - and sitting really makes my hip ache. I sometimes feel like I've got a groin strain in my right side too, not all the time though. Walking and cycling are fine - lying in bed and sitting are hellish though. Bed situation improved by putting pillow between my knees.

Just feeling very despondent that this doesn't seem to be getting better. I can't sleep with a pillow between my knees for ever or my hubby will leave me!

Can you wonderful people a) confirm that this joint is the problem and b) that the damned thing can be put right?!

Best regards - fabulous site btw!

Heck - forgot to say that when I stand and try to curl forward a vertebrae at a time, I get to my lower back and everything just seems to bend forward as a single unit and my pelvis hurts (stretches?) on the right side.

Also, when I lie on the floor and try to let my spine drop onto the floor, vertebrae at a time, by the time I get to my lower back, it just flubs onto the floor like it's all welded together.

I feel like an old lady and I'm 44.

AX

Allison,

From reading your history, it sounds as if you have a classic case of a transversus abdominus muscle that is not functioning or at best, is very weak. It is not possible to say whether or not your SI joint is the cause of your back pain. The beauty of Dean's exercises are that they will help most folks that have back problems because of deconditioned musculature in the lower back and abdomen which happens to be a high % of people that have back pain. For example, the "Prone Cobra" is excellent for developing the intrinsic stabilization musculature of the back. Very often, in folks that have back pain, these smaller stabilizer muscles have lost their ability to help stabilize the vertebrae of the back which can eventually result in various back conditions.

Allison, did your doctor check you for anklylosing spondylitis? Ankylosing spondylitis is an inflammatory condition of the spine which predominantly affects men about twice as often as women. I am mentioning this because you wrote (relating to your description of your lower back) "Everything just seems to bend forward as a single unit". Ankylosed means immobility of a joint. Also, did your doctor say you had a flat back or a sway back? They are different, but look very similar when viewed from the side; both have the flat butt appearance. In either case, I would refrain from doing the Prone Cobra exercise at least until you have developed greater strength in the iliopsoas musculature. This course of action will benefit you whether you have a vertically aligned flat back, or you have a sway back. The reasoning behind my recommendation to avoid the prone cobra are taken directly from "Muscles, Testing and Function" by Kendall, McCreary & Provance ": 1) "Careful consideration must be given to examination findings when planning a course of treatment. It is a mistake to assume that extension exercises are indicated. They may be unnecessary or may be contraindicated. The flat back posture is one in which the hip joint is in extension, and the hamstrings are strong, and usually short. 2) If this type of posture exists without low back pain, it is not necessary to change it. If the back is painful, and restroring the normal anterior curve is indicated, the measure of choice should be strengthening the weak hip flexors. The problems with back extension from prone position are that it involves strong hip joint extension, and extensor muscle action to stabilize the pelvis to the thigh in order for the trunk to be raised, and the hip extension stretches the already weak illiopsoas."

Here is a little information on pain. Central Pain syndrome, which I think most back pain falls under, is damage or disfunction to the brain, brain stem or spinal cord. This type of pain is typically characterized by a constant level of pain; whether it be moderate or severe. With back pain, the level of pain is directly related to the severity of disruption to the nerve(s). Central Pains actions should not be confused or compared to that which is normally felt in peripheral pain.

An example of peripheral pain would be if you stubbed your toe; the amount of pain you feel initially is much greater than what is present 2 or 3 minutes later. In short, as time passes, there is a diminishing quality to the perceived level of pain from the trauma. On the other hand, with back pain or central pain, because of the initiation of mitogin-actived protein kinase within the body, pain can remain at a constant level much longer.

With central pain, the body initiates a complex process that places a high-energy phosphate (kinase) bond on the pain neuro transmitters which can make the affected nerves fire out of control signalling pain. You can feel pain locally or referred (feels as if it comes from one place, but actually comes from somewhere else) or radicular pain, which has that shooting sensation radiating from a nerve root towards its' periphery.

The point I'm trying to make here is don't despair - you may actually have made progress, but your pain level is telling you otherwise. I think when a spinal injection has a successful outcome in alleviating pain, the groundwork had already been laid by the events previous (i.e. exercises, stretches, rest, massage). In cases where the spinal injection is ineffective, the cause (etiology) may still be present, hence the pain eventually returns. However, in cases where the pain is so severe as to be physically debilitating, an epidural may serve to provide sufficient relief from the pain to allow the individual to perform the physical exercises that will form the foundation for the best chance of recovery.

The following is the course of action I would take:1. Ask your doctor whether he found any indications you may have ankylosing spondylitis?2. Hold off on performing the Prone Cobra.3. On days you want to take corrective action (hopefully 3 or 4 times per week), first stretch your hamstrings, followed by an exercise for your illiopsoas muscles.4. Follow the illiopsoas exercise with a transversus abdominus exercise.5. Then follow the exercises in Dean's book.

Allison, if you want to follow my suggestions, I will be happy to provide the stretches and exercises.

Alison Cross wrote:Hello all - stumbled across this site while trying to find out what the heck is wrong with my hip and have paid for and downloaded the RYB book today.

I've been to the doctor and had an x-ray taken - nothing seems to be wrong bone-wise (which is good!). He signed me up for 6 sessions of physiotherapy and I've been attending religiously, but to be honest, my pain didn't improve. So, I went to an osteopath who said that he reckoned it was my SI joint.

I went twice - got a jolly good cracking up and down my back - but nothing improved.

From what I've read on the internet, I reckon that it is my joint. I'll give you a potted history.

Had my appendix out in mid eighties - nast big scar still there. Had my son by caesar section in 2000 - so abdomen has been well cut up! Developed sciatica whilst pregnant and attended a sports physio after son born - this helped enormously (left hip - down leg, heel pain etc).

Everything pretty much ok until last August. Dancing with son, swung hips out to right side, heard a bit of a crack on right side....no pain....but ever since then, hip pain and back pain been gradually getting worse.

When I lie on my back with my knees up to my chest and rock over my right hip, I can hear a click (not all the time). No noise on left side.

Got a bit of a flat back thing going on (no bottom!) but being doing the cobra to improve that (the physio helped me with this bit).

I spend a lot of time sitting at the computer - and sitting really makes my hip ache. I sometimes feel like I've got a groin strain in my right side too, not all the time though. Walking and cycling are fine - lying in bed and sitting are hellish though. Bed situation improved by putting pillow between my knees.

Just feeling very despondent that this doesn't seem to be getting better. I can't sleep with a pillow between my knees for ever or my hubby will leave me!

Can you wonderful people a) confirm that this joint is the problem and b) that the damned thing can be put right?!

Best regards - fabulous site btw!

Heck - forgot to say that when I stand and try to curl forward a vertebrae at a time, I get to my lower back and everything just seems to bend forward as a single unit and my pelvis hurts (stretches?) on the right side.

Also, when I lie on the floor and try to let my spine drop onto the floor, vertebrae at a time, by the time I get to my lower back, it just flubs onto the floor like it's all welded together.

I feel like an old lady and I'm 44.

AX

Allison,

From reading your history, it sounds as if you have a classic case of a transversus abdominus muscle that is not functioning or at best, is very weak. It is not possible to say whether or not your SI joint is the cause of your back pain. The beauty of Dean's exercises are that they will help most folks that have back problems because of deconditioned musculature in the lower back and abdomen which happens to be a high % of people that have back pain. For example, the "Prone Cobra" is excellent for developing the intrinsic stabilization musculature of the back. Very often, in folks that have back pain, these smaller stabilizer muscles have lost their ability to help stabilize the vertebrae of the back which can eventually result in various back conditions.

Allison, did your doctor check you for anklylosing spondylitis? Ankylosing spondylitis is an inflammatory condition of the spine which predominantly affects men about twice as often as women. I am mentioning this because you wrote (relating to your description of your lower back) "Everything just seems to bend forward as a single unit". Ankylosed means immobility of a joint. Also, did your doctor say you had a flat back or a sway back? They are different, but look very similar when viewed from the side; both have the flat butt appearance. In either case, I would refrain from doing the Prone Cobra exercise at least until you have developed greater strength in the iliopsoas musculature. This course of action will benefit you whether you have a vertically aligned flat back, or you have a sway back. The reasoning behind my recommendation to avoid the prone cobra are taken directly from "Muscles, Testing and Function" by Kendall, McCreary & Provance ": 1) "Careful consideration must be given to examination findings when planning a course of treatment. It is a mistake to assume that extension exercises are indicated. They may be unnecessary or may be contraindicated. The flat back posture is one in which the hip joint is in extension, and the hamstrings are strong, and usually short. 2) If this type of posture exists without low back pain, it is not necessary to change it. If the back is painful, and restroring the normal anterior curve is indicated, the measure of choice should be strengthening the weak hip flexors. The problems with back extension from prone position are that it involves strong hip joint extension, and extensor muscle action to stabilize the pelvis to the thigh in order for the trunk to be raised, and the hip extension stretches the already weak illiopsoas."

Here is a little information on pain. Central Pain syndrome, which I think most back pain falls under, is damage or disfunction to the brain, brain stem or spinal cord. This type of pain is typically characterized by a constant level of pain; whether it be moderate or severe. With back pain, the level of pain is directly related to the severity of disruption to the nerve(s). Central Pains actions should not be confused or compared to that which is normally felt in peripheral pain.

An example of peripheral pain would be if you stubbed your toe; the amount of pain you feel initially is much greater than what is present 2 or 3 minutes later. In short, as time passes, there is a diminishing quality to the perceived level of pain from the trauma. On the other hand, with back pain or central pain, because of the initiation of mitogin-actived protein kinase within the body, pain can remain at a constant level much longer.

With central pain, the body initiates a complex process that places a high-energy phosphate (kinase) bond on the pain neuro transmitters which can make the affected nerves fire out of control signalling pain. You can feel pain locally or referred (feels as if it comes from one place, but actually comes from somewhere else) or radicular pain, which has that shooting sensation radiating from a nerve root towards its' periphery.

The point I'm trying to make here is don't despair - you may actually have made progress, but your pain level is telling you otherwise. I think when a spinal injection has a successful outcome in alleviating pain, the groundwork had already been laid by the events previous (i.e. exercises, stretches, rest, massage). In cases where the spinal injection is ineffective, the cause (etiology) may still be present, hence the pain eventually returns. However, in cases where the pain is so severe as to be physically debilitating, an epidural may serve to provide sufficient relief from the pain to allow the individual to perform the physical exercises that will form the foundation for the best chance of recovery.

The following is the course of action I would take:1. Ask your doctor whether he found any indications you may have ankylosing spondylitis?2. Hold off on performing the Prone Cobra.3. On days you want to take corrective action (hopefully 3 or 4 times per week), first stretch your hamstrings, followed by an exercise for your illiopsoas muscles.4. Follow the illiopsoas exercise with a transversus abdominus exercise.5. Then follow the exercises in Dean's book.

Allison, if you want to follow my suggestions, I will be happy to provide the stretches and exercises.

What tests you use to diagnose it? Are they osteopathian, physioterapian, chiropractic on some other manual therapy tests?
Provocation tests? Palpation tests? Flexion tests?
And what do you look with the tests?

This reply is based on the assumption that your question concerned ankylosing spondylitis. If so, a rheumatologist is the physician of choice. They are highly trained in diagnosing joint inflammation. Ankylosing spondylitis falls in the family of approximately 100 different rheumatic diseases.

Ankylosing Spondylitis is a chronic condition (i.e. lasting 3 months or longer) normally characterized by back pain and stiffness which worsens at night or with inactivity. Light physical activity such as light stretching, swimming, or physical therapy often help alleviate some of the symptoms.

A thorough physical exam along with blood work and X-rays are commonly used to help the physician make a diagnosis. HLA-B27, a protein found on the white blood cells, is a marker used to help determine whether a person has an affinity to develop A.S.

There is no definite single indicator confirming the presence of this illness. X-rays can confirm A.S., but it takes 7-10 years for the disease to become prominent enought to show up on an X-ray. Men represent the largest group afflicted with A.S. the onset is usually between ages 17-35

Bill - thanks for taking the time and trouble to reply, my comments are @@@@@ interspersed in your reply
Allison,

From reading your history, it sounds as if you have a classic case of a transversus abdominus muscle that is not functioning or at best, is very weak. It is not possible to say whether or not your SI joint is the cause of your back pain. The beauty of Dean's exercises are that they will help most folks that have back problems because of deconditioned musculature in the lower back and abdomen which happens to be a high % of people that have back pain. For example, the "Prone Cobra" is excellent for developing the intrinsic stabilization musculature of the back. Very often, in folks that have back pain, these smaller stabilizer muscles have lost their ability to help stabilize the vertebrae of the back which can eventually result in various back conditions.

@@@@@@ I've been doing the exercises since I posted this and am delighted to report that I'm having many more good days than bad days! The main difference is, I feel as though I AM in control of my back and am not a passive 'victim' of back pain.

Allison, did your doctor check you for anklylosing spondylitis? Ankylosing spondylitis is an inflammatory condition of the spine which predominantly affects men about twice as often as women.

@@@@@@ My doctor didn't mention it as a possible problem, but I'm going to see him next week about an unrelated issue and will ask him about it.

I am mentioning this because you wrote (relating to your description of your lower back) "Everything just seems to bend forward as a single unit". Ankylosed means immobility of a joint. Also, did your doctor say you had a flat back or a sway back?

@@@@ Flat back was the phrase used, Bill.

They are different, but look very similar when viewed from the side; both have the flat butt appearance. In either case, I would refrain from doing the Prone Cobra exercise at least until you have developed greater strength in the iliopsoas musculature. This course of action will benefit you whether you have a vertically aligned flat back, or you have a sway back. The reasoning behind my recommendation to avoid the prone cobra are taken directly from "Muscles, Testing and Function" by Kendall, McCreary & Provance ": 1) "Careful consideration must be given to examination findings when planning a course of treatment. It is a mistake to assume that extension exercises are indicated. They may be unnecessary or may be contraindicated. The flat back posture is one in which the hip joint is in extension, and the hamstrings are strong, and usually short. 2) If this type of posture exists without low back pain, it is not necessary to change it. If the back is painful, and restroring the normal anterior curve is indicated, the measure of choice should be strengthening the weak hip flexors. The problems with back extension from prone position are that it involves strong hip joint extension, and extensor muscle action to stabilize the pelvis to the thigh in order for the trunk to be raised, and the hip extension stretches the already weak illiopsoas."

@@@@@@@ I've always had a bit of trouble with the cobra. I had been trying to do it with straight arms until I downloaded the book. I've been doing it with my elbows and forearms on the floor and handling it much better. However, am very concious of the fact that my buttock muscles clench up a great deal in this exercise and it takes great concentration to keep remembering to relax them! I shall take your advice about this exercise on board. If I've just got a flat back, may I continue the cobra?

Here is a little information on pain. Central Pain syndrome, which I think most back pain falls under, is damage or disfunction to the brain, brain stem or spinal cord. This type of pain is typically characterized by a constant level of pain; whether it be moderate or severe. With back pain, the level of pain is directly related to the severity of disruption to the nerve(s). Central Pains actions should not be confused or compared to that which is normally felt in peripheral pain.

An example of peripheral pain would be if you stubbed your toe; the amount of pain you feel initially is much greater than what is present 2 or 3 minutes later. In short, as time passes, there is a diminishing quality to the perceived level of pain from the trauma. On the other hand, with back pain or central pain, because of the initiation of mitogin-actived protein kinase within the body, pain can remain at a constant level much longer.

With central pain, the body initiates a complex process that places a high-energy phosphate (kinase) bond on the pain neuro transmitters which can make the affected nerves fire out of control signalling pain. You can feel pain locally or referred (feels as if it comes from one place, but actually comes from somewhere else) or radicular pain, which has that shooting sensation radiating from a nerve root towards its' periphery.

The point I'm trying to make here is don't despair - you may actually have made progress, but your pain level is telling you otherwise. I think when a spinal injection has a successful outcome in alleviating pain, the groundwork had already been laid by the events previous (i.e. exercises, stretches, rest, massage). In cases where the spinal injection is ineffective, the cause (etiology) may still be present, hence the pain eventually returns. However, in cases where the pain is so severe as to be physically debilitating, an epidural may serve to provide sufficient relief from the pain to allow the individual to perform the physical exercises that will form the foundation for the best chance of recovery.

The following is the course of action I would take:
1. Ask your doctor whether he found any indications you may have ankylosing spondylitis? @@@@@@ will do
2. Hold off on performing the Prone Cobra. @@@@@@@ will do
3. On days you want to take corrective action (hopefully 3 or 4 times per week), first stretch your hamstrings, followed by an exercise for your illiopsoas muscles. @@@@@@ yes, hamstrings are tight! Will do this
4. Follow the illiopsoas exercise with a transversus abdominus exercise.
5. Then follow the exercises in Dean's book.

Allison, if you want to follow my suggestions, I will be happy to provide the stretches and exercises. @@@@@@@ Yes please!

Dean's book has made me feel very much in control of my spine and even when my hip is sore, I can alleiviate the situation now with some stretches from the book.

I've been recommending this site to lots of other back pain sufferers that I know, but it's amazing how many people say 'yeah, well, I've tried exercises and they don't work' - as if they WANT to continue their existing situation.

Bill P wrote:Sijtoni,This reply is based on the assumption that your question concerned ankylosing spondylitis.

No, sorry, it was not. I was simply commenting about the most common disorder of humans. This topic named it "sacroiliac strain". Other specialist call it as sacroiliac joint dysfunction. Some call it as pain in SIJ, but pain is just one symptom and not always present. Same disorder have many other names too. It is very common.

I am sad that no-one answered my question even when this problem concerns millions of people, and animals...

The importance of the progress you feel you have made cannot be overlooked. Therefore, I would recommend that you continue to follow your current program; including the prone cobra.

Although I previously discouraged you from performing the prone cobra, sometimes we have to alter conventional wisdom, and use gut instinct, intuition, or our own results as our gauge in exercise selection. Just be cognizant of the fact that the prone cobra is normally contraindicated for a flat back posture.

One other suggestion I will make is to perform the exercise I am supplying first, followed by your present routine. The reason here is based on the rule that, whatever exercise is done first receives the best results. Any subsequent exercise you perform will receive slightly less benefit. Normally with the flat back posture the one-joint hip flexors are weak. So, using the exercise rule above, the best placement for a hip flexor exercise in your case would be first. In an effort to restore proper alignment to your pelvis, it is important to first stretch the tight hamstrings. The hamstring stretch I recommend is a "Lying Hamstring Stretch" done as follows:

1. Roll a towel up the thickness and width of the widest part of your hand. Lie supine (face up) and place the towel under your lower back. While leaving one leg extended straight out and flat on the floor, bring the other leg up (in this case the left leg) with the knee bent, pivoting at the hip. Support the raised leg with the hand that is on the same side as the raised leg by placing the hand between the hip and the knee to help keep the leg vertical (in this case, your left hand will be holding your left leg).

2. Slowly extend the lower leg upward (with the toes pointed toward the shin) until you feel tightness in the back of your thigh. Hold a comfortable stretch for 20 seconds, then switch sides. Alternate stretching 3 times on each side.

If any part of this stretch brings you discomfort or pain, discontinue this stretch. Once you have completed the hamstring stretches on both legs, try this hip flexor exercise. The "Standing hip flexion" can be perfomed while holding onto a kitchen counter if you need the support to aid with balance. If balance is not an issue, place your hands on your hips.

2. If you need the counter to aid with balance, stand sideways to the counter so that your right hand falls just to the outer edge of the counter. Raise the left leg (let your knee bend so that your foot stays facing the floor) in a slow tempo until the thigh is parallel to the floor. *Note* if your lower back flexes when your thigh nears the horizontal postition, limit the leg raise so that you do not alter the position of the lower back.

3. Pause 1 second at the top horizontal position, then lower, taking a full 3 seconds to completely lower the leg until your foot touches the floor. Again, pause 1 second with the foot on the floor. continue working the same leg until you feel a slight fatigue in the upper thigh or until your form breaks down. All repetitions should look the same.

Once you have the movement down, pay attention to your torso; keep it quiet, make sure you are not rocking or extending backward as the leg comes up. Bring the leg straight up and not out to the side. Make sure to rest 2 full minutes before changing sides.

The first two times you do this exercise, only perform one set on each leg; thereafter, two sets will do. Initially, do not wear sneakers. Wait until you can do at least twenty perfect reps on each leg twice. Then adding the sneakers will increase the resistance of the movement. Again, stop if this exercise causes any discomfort in your back or elsewhere.

I wasn't trying to ignore the information you provided in your post with regard to a "flat back" or a "sway back"; there is just a subtle difference between the two.

Thanks for the sincere effort you made to perform the exercise. Write back with your progress.

I apologize; somehow I just assumed your question was related to my previous post in which I referenced ankylosing spondylitis.

Determining whether your pain comes from the SI joint involves deductive reasoning as there is no single test to confirm or deny that the pain emanates from the sacroiliac joint.

Initially, diagnosis involves a patient-specific history and a physical examination. there are three excellent tests for determining if your SI joint is causing your low back pain; the 'Patrick Test" the"Gaenslen Test"and "The Spring Test".With the "Patrick Test" the examiner has you move your leg into different positions, and if the pain is reproduced, it indicates that excess SI joint mobility is probably causing the pain.

The "Spring Test" can help determine whether the SI joint is the source of pain. The "Spring Test" is a passive test that has you lying in the prone position (face down) with a towel placed under your anterior superior iliac spine (that's the top front edge of the pelvis). With this test, the examiner applies downward pressure over your sacrum, then if the pain reappears, or becomes worse, it is a positive sign that the pain is coming from your SI joint.

Because of the bone density in the area of the SI joint, x-rays often won't clearly show problems in this area. Your doctor may recommend a CT scan or an MRI scan. He/She may also recommend a diagnostic injection which numbs the area immediately around the SI joint. If this injection relieves the pain, it indicates the culprit may be the SI joint.

Many experts in this field do not agree that disfunction of the SI joint is primarily responsible for the majority of pain from this region of the back. Experts taking the opposing view feel that pain in the SI joint is NOT caused by movement or disfunction, but rather arises from stress of the tissues that directly attach in this area. However, it should be noted that the numbing effects of the diagnostic injection may not be limited to the SI joint, but may extend to the tissues surrounding the joint, further supporting the opposing view.

Bill P wrote:Determining whether your pain comes from the SI joint involves deductive reasoning as there is no single test to confirm or deny that the pain emanates from the sacroiliac joint.

No, pain from SIJ is not a cause of pain but just a symptom, called pain. Sure there are no good test to find if there is SIJ pain or not, especially if pain is mild. Some experts can cause pain to SIJ with all people with some of those tests. Some experts cant't produce pain to any. Most are between them.

But to produce pain is not to look for the cause of pain.

If you don't understand the cause of SIJ pain you use provocation tests. Dysfunction in SIJ causes symptoms to many places, pain in SIJ is just one of them and not even the most common symptom.

Many people have only pain in knee, hip, groin or mid back because of SIJ dysfunction/pelvic malalignmnet/ilium uplift/SIJ out of place/etc.. And there are many other names too, most of them describe the cause of pain much better. And sure there are many other symptoms not just pain. Leg weakness is one common symptom, and scoliosis too.

Bill P wrote:Initially, diagnosis involves a patient-specific history and a physical examination. there are three excellent tests for determining if your SI joint is causing your low back pain; the 'Patrick Test" the"Gaenslen Test"and "The Spring Test".

According to many medical studies those are quite poor tests. And they only try to find pain in SIJ not the cause of pain as SIJ dysfunction. Experts who use those test have no idea what is causing the pain.

Bill P wrote:With the "Patrick Test" the examiner has you move your leg into different positions, and if the pain is reproduced, it indicates that excess SI joint mobility is probably causing the pain.

Yes, it will find pain in SIJ. But not the cause of pain. And usually the pain, caused by malalingned pelvis / ilium uplift, is on somewhere else than on SIJ.

Bill P wrote:The "Spring Test" can help determine whether the SI joint is the source of pain. The "Spring Test" is a passive test that has you lying in the prone position (face down) with a towel placed under your anterior superior iliac spine (that's the top front edge of the pelvis). With this test, the examiner applies downward pressure over your sacrum, then if the pain reappears, or becomes worse, it is a positive sign that the pain is coming from your SI joint.

Again that test looks for pain, not the cause of pain.You have to understand that if you have pain in SIJ you have pain in SIJ. But that test doesn't tell why you have pain on that SIJ.

Bill P wrote:Because of the bone density in the area of the SI joint, x-rays often won't clearly show problems in this area. Your doctor may recommend a CT scan or an MRI scan.

On those pictures you see inflammation if it is severe. But you can't see the cause of the inflammation.

Bill P wrote:He/She may also recommend a diagnostic injection which numbs the area immediately around the SI joint. If this injection relieves the pain, it indicates the culprit may be the SI joint.

According to many studies injection of SIJ area is for SIJ pain but not correcting the cause of SIJ pain. Many patients get their pains back after few weeks of injection.

Bill P wrote:Many experts in this field do not agree that disfunction of the SI joint is primarily responsible for the majority of pain from this region of the back.

Yes. I find that very sad but understandable. Only very few understand how pains develop and why. Why disc problems and degeneration developes and why. Etc.There are many kind of experts on this area. Here I have few categories:

1) Most medical experts say there can not be a "dysfunction" in SIJ because SIJs are the strongest places in human body.2) Some experts describe it as "pain in SIJ" and that pain many times "radiates" to some other places. They explane SIJ dysfunction as SIJ ligament "damage". They diagnose it by looking for pain by using provocation tests - many times patient complaining pain in SIJ area is enough for diagnose. Then they treat it by not treating it. Talking about SIJ belt or injections are their best knowledge.3) Few experts keep telling SIJ dysfunction is a "subluxation" of a joint and pain tells which side that unknown "subluxation" is. They may also call it as anteriorly or posteriorly rotated innominate (or ilium) or just "blocked" SIJ. They sometimes use palpation to see the pelvic asymmetry and then they use provocation tests to find the pain and tell the problem is there where the pain is.4) Some few experts explane SIJ dysfunction as SIJ is "out of place" or "ilium upslip" or "malaligned pelvis".They tell there can be found pelvic motion asymmetry on almost all pain patients. Also many experts tell that lumbar spine problems (disc problems and degeneraton) come from malfunction on the pelvis. Also most knee, feet, groin. buttock and spinal problems. It has even effect to neck and shoulders.

Which group do you belong to?

Bill P wrote:Again, sorry for the inaccurate reply. I hope this is of some help.Bill P.

Don't worry. This is very poorly understood subject. My guess is that 99% of medical experts have no clue wht it really is because most of them belong to group 1 and 2 as I explaned above.

I am not saying I belong to any of them. I just see the difference of the opinions...

Hi All-
I am new here . . . stumbled across this site while "googling" sacroiliac joing pain. Anyway, I have had pain for two years now - it started during my pregnancy. I went to physical therapy during/after my pregnancy with no change in pain. More recently I have been seing a chiropractor who did spinal manipulation as well as a technique known as graston on me. My plan is to go back to physical therapy, but here is my question: my daughter is now 19 months old and still breastfeeding. Do you think that my ligaments could still be loose and that is why I am having no luck with my treatments.

backpain wrote:Hi All-I am new here . . . stumbled across this site while "googling" sacroiliac joing pain. Anyway, I have had pain for two years now - it started during my pregnancy. I went to physical therapy during/after my pregnancy with no change in pain.

What was the diagnosis? Where is the pain?

backpain wrote:More recently I have been seing a chiropractor who did spinal manipulation as well as a technique known as graston on me.

That is what most chiropractors do. They don't correct the position of sacroiliac joints, they only treat the spine. Some of them understand the meaning of SIJs, but only very few.

backpain wrote:My plan is to go back to physical therapy, but here is my question: my daughter is now 19 months old and still breastfeeding. Do you think that my ligaments could still be loose and that is why I am having no luck with my treatments.

It is impossible to say like this. Every patient is different. When the correction is done as it should the pains will disappear immediately. If the pains come back after a while the correction didn't hold. Then you need to consentrate on those exercises to make it stay better or in worst cases, think about proloteraphy... If the pain does not disappear after the treatment then the treatment isn't what it should be. 99% of the experts only do the things they have been tought without understanding what they are doing and why...

Hello,I am 36 yrs old. I used to be very active person. I've had 2 knee surgeries and one ankel with torn ligaments that resulted in one flat foot. I broke my tailbone when I was 25, I got a few steroid injections and it was healed and never had problems with it again. I have 2 kids, one 10 and one 2. When I was pregnant with my 2nd child my "tailbone area" started hurting very badly. As a result, I gaine about 35 lbs due to my sudden inactivity. After baby was born, pain went away. I lost almost all my weight exercising again. 6 mos ago my hip,low back tailbone pain came back, this time with avengence. I went to the dr, she made a coment about getting to a certain age and lifting toddlers in and out of car seats etc. I was very offended by that coment. I am not old, and I considerd myself in good shape. I was also a Elem. PE teacher at the time. Anyways, I went back 2weeks later, and the muscle relaxers had decreased the intensity of the flareup ( other areas of my back were starting to hurt for me compensating for the pain in my low back) but the burning pain was still deep in my hip and always there.

Anyways, I've since been to a chiropractor that measured my legs. My leg length discrepency is almost 1/2 inch. She gave me an insert to put in my shoe, at first I thought it was helping, but now everything is back to where I started.

My questions are:what is the exercise book everyone is talking about ?has anyone been "healed" from their SIJ "dysfunction"Because I tell you, this pain has sucked the life out of me. I am not doing the things I used to do. My pain is always there.

I feel like a link in my core is weakened. strength and stability are diminished.

A hypermobile SI joint is one in which there is an above-normal amount of movement within that joint. Let me also point out that some textbooks do not consider the SI joint to be a joint in the typical sense of the word. One of the reasons is because there is very little movement within this joint. Therefore, anything more than normal is considered to be hypermobile. One other point that may be of interest is the fact that the SI joint has slightly more movement during childbirth. In any event, the SI joint has two areas or planes of articulation. On average, movement from the SI joint is in the neighborhood of 1-2 millimeters, and is very hard to measure. Also, by the age of 50, this joint is fused or "ankylosed" in a high percentage of the population. I do not remember the exact percentage.

Were your knee surgeries on the same knee, and if so, were they also on the same side as your ankle which had the torn ligaments? Often, doctors make comments as yours did about back pain because they realize how complex an area this can be to correct. And since they don't know how most back conditions occur, and what is needed to restore proper function, you will receive a generalized,broad-based answer similar to your doctors' reply.

The majority of back pain comes from 2 sources; a single trauma or an accumulation of "microtraumas". A single trauma, or a single traumatic event, is as the name implies, a serious injury or shock to that region of the body. In this type of situation, there is usually no doubt as to the event that precipitated your back pain. Examples are falls, auto accidents, lifting an object that is much heavier than what you are normally accustomed to.

The most common cause of back pain is the second category referenced above; the accumulation of 'microtraumas". Microtraumas to the connective tissue in an individual's back are often a result of very repetitive, yet common movements we do every day. Note that they are called "microtraumas" and not macro-traumas because they occur at a level too deep within the body and too subtle for an individual to feel as they occur. Nevertheless, damage is being done to the mechano-receptors within the ligaments. Any movement that's performed w/poor posture or without a stable core will result in microtraumas.

The following technical explanation of chronic pain was published in the European spine journal July 27th, 2005 by Dr. Panjabi. Dr Panjabi has been a professor at Yale University for the past 30yrs. He is argueably the world's leading authority on biomechanics of the spine. His new hypothesis for back pain consists of the following steps:
1. Single trauma or cumulative microtrauma causes subfailure injury to the spinal ligaments, and injury to the mechano-receptors imbedded in the ligaments.
2. Altered, corrupted mechanical input is sent to the spinal cord.
3. Altered, corrupted mechanical input to the spinal cord results in corruption of the neuro-muscular control and coordination of spinal function.
4.The corrupted muscle response pattern leads to corrupted afferent feedback to the spinal cord via tendon organs of muscles and injured mechno-receptors; further corrupting the muscle response pattern.
5. The corrupted muscle response pattern produces high stresses and strains in spinal components, leading to further subfailure injury of the spinal ligaments, mechano-receptors, and muscles, and overload of facet joints.
6. The abnormal stresses and strains produce inflammation of spinal tissues which have an abundant supply of nociceptive sensors and neural structures.
7. Over time, chronic back/neck pain develops.

To answer your question about Dean's book, here is a look at the chapters:

1.Why did I hurt my back?
2. The good news.
3.How to heal your back.
4.Rebuilding your back Part I.
5. Shoring up the foundation.
6. Rebuilding your back Part II.
7. Final thoughts.

As you can see, he covers the how and why of back pain. Better yet, the exercises in the book will help most people get back their lives, and start the rebuilding process. Another point I should make is that the exercises can be done at home with little or no equipment needed. The simple, but effective exercises in Dean's book strengthen often overlooked and weak tonic muscles that help keep the spine in good health.

The short answer to your question, has anyone been healed from SI joint dysfunction is YES. This condition, although hard to identify is very correctible. It has the same symptoms as piriformis syndrome which brings about the same pain patterns and discomfort. Dr Panjami's explanation about the mechanical causes that bring about back pain also apply to SI joint dysfunction, as well as whiplash-type injuries.

I would recommend you download Dean's book and follow the exercises in it; it is well worth the price of the book!

Another exercise that is paramount for a strong core is the one I posted on page 1 of this topic to Karen on March 4th, 2007. This simple but effective exercise targets the transversus abdominus muscle (TVA). If the TVA is weak, or not working, you will experience back pain sooner rather than later. The TVA is the body's natural weight belt; it stabilizes the midsection of the body more so than any other single muscle.

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